US hospitals close paediatric intensive care units, forcing sickest children to travel farther

Mixed · 2Hospitals across the US are closing units that treat critically ill children. In the past year, paediatric intensive care units (PICUs) have closed in Montana, Oregon and Missouri, and overnight children's wings have shut in Illinois and California. 1 2 Mixed · 2Hospitals often convert the beds to services for newborns or adults to cut costs. As a result, paediatric intensive care is becoming centralised in medical hubs, and critically ill children must travel farther for care. 1 2 Mixed · 2Hospitals cutting paediatric care cite low patient volumes, because it is relatively rare for a child to need intensive care. They also cite a shortage of paediatric subspecialists, who earn less than adult-focused doctors. Hospitals are often paid less to treat children than adults, and equipment tailored to children adds cost. 1 2

Mixed · 2A recent analysis found paediatric inpatient units fell by nearly 30% from 2008 to 2022, from 1,749 hospitals to 1,226, leaving three-quarters of hospitals without any paediatric inpatient services. The gap is most acute in rural areas, and cuts are happening at community hospitals owned by small nonprofits and by large private equity companies alike. 2 1 Mixed · 2In Missoula, Montana, Community Medical Center closed its PICU this month. CEO Greg Cook said most children will still be treated there, but the sickest, for example those needing a ventilator, will be stabilised and sent elsewhere. He said the hospital saw about two children a month needing intensive care and estimated the closure will affect roughly 25 patients a year. The next-closest PICU in the state is in Kalispell, about 150 miles north. 1 2 Centre · 1Cook said the decision was "about quality more than it is about the dollars". A hospital spokesperson, Megan Condra, later said it was driven by low patient volumes and long-standing staffing challenges, not by concerns about current quality of care. Cook said the hospital has been unable to recruit a resident paediatric critical care doctor since the last one retired eight years ago, relying on visiting specialists. 2

Centre · 1The hospital is owned by for-profit Lifepoint Health, whose revenue is more than $10 billion a year according to its website; Cook said asking Lifepoint to fund the programme would not have solved the main problem. In Portland, Oregon, St. Vincent Medical Center, part of the nonprofit Providence, closed its four-bed PICU last November. Its spokesperson Lisa Helderop said the unit was often empty, and that low patient numbers rather than money were the main reason, though Providence Oregon had a shortfall of more than $15 million as of 2024. 2 Mixed · 2Elizabeth Mack, a paediatric critical care doctor and spokesperson for the American Academy of Pediatrics, called cutting children's services "a spreadsheet issue" and said the endeavour is expensive and not sustainable. She warned that people cannot be expected to be fine if the next children's hospital is a flight or an eight-hour drive away. 1 2 Mixed · 2Raj Basu of Lurie Children's Hospital of Chicago and the Society of Critical Care Medicine said hospitals taking on complex paediatric cases without the right doctors could put patients at risk. He noted that falling birth rates, earlier diagnosis and vaccines have lowered volumes at community hospitals, while the children who do need critical care have more complicated conditions. He said clinicians sense children are arriving sicker, but "I don't know that we have enough data yet to prove that." 2 1

Mixed · 2Researchers and organisations warn the gaps will widen because of cuts in federal Medicaid spending. The article says the Trump administration has added administrative hurdles and narrowed eligibility, mostly affecting adults, but about half of US children are covered by Medicaid or the Children's Health Insurance Program, and paperwork can cost children coverage. Fewer enrollees would mean a financial hit for hospitals. 2 1 Mixed · 2Proposed responses include regional training and transfer protocols between specialty centres and community hospitals, more federal funding for services in low-access areas, and higher Medicaid reimbursement rates. Study lead author Kenneth Michelson said there is a case that the capacity is not needed, but it should be seen as a national necessity. He warned that regional centres could be overwhelmed by demand spikes, as in 2022 when community emergency departments had to call 10, 15 or 20 hospitals to place a patient, and noted that hospitals performing paediatric appendectomies fell by more than half from 2003 to 2022. 1 2 Centre · 1Lauren Wilson, a paediatrician at the Missoula hospital, said it keeps a newborn intensive care unit, inpatient paediatric services, emergency care, surgeons, therapists and some subspecialists, and that local doctors can consult specialists elsewhere to stabilise and transfer children. 2